tbuckley/cabot-search huggingface dataset:
Treatment of Aspiration Pneumonia and Primary Lung Abscess
Authors: John G. Bartlett
Journal: JAMA (1975)

Aspiration pneumonitis and lung abscess generally involve anaerobic bacteria, which normally colonize the upper respiratory passages. The therapeutic response of these infections to parenteral penicillin G (49 patients) and parenteral clindamycin (35 patients) was compared to determine relative efficacy. No difference was discerned between these two agents in terms of time required for defervescence, roentgenographic clearing, and ultimate outcome. Seven patients with infections including<i>Bacteroides fragilis</i>were treated with penicillin G, and all responded well. These data indicate that penicillin G is the preferred agent for pulmonary infections involving anaerobic bacteria. Clindamycin is a suitable alternative for patients in whom penicillin G is contraindicated. (<i>JAMA</i>234:935-937, 1975)
Late Onset of Gold-Induced Thrombocytopenia
Authors: Benjamin T. Stafford
Journal: JAMA (1978)

GOLD-INDUCED thrombocytopenia has been recognized since the 1930s, when colloidal gold became widely used for treating rheumatoid arthritis.<sup>1</sup>The appearance of thrombocytopenia several months after gold therapy is well reported,<sup>2-5</sup>but we have recently seen a patient in whom severe purpura developed 18 months after the last gold injection. So far as we know, this is a record for time elapsed before the onset of gold-related thrombocytopenia. <h3>Report of a Case</h3> A 76-year-old man was examined at Scripps Clinic in 1971 for polymyalgia and fever thought to be polymyalgia rheumatica. At another clinic, a diagnosis of seropositive rheumatoid arthritis was made, and the patient was treated between January 1973 and July 1974 with 2,000 mg of gold sodium thiomalate by the usual regimen of decreasing frequency of injections. He had notable clinical improvement during and after this therapy. Eighteen months later (January 1976), he was hospitalized with epistaxis,
Ileal Bypass in Patients With Hypercholesterolemia and Atherosclerosis
Authors: Henry Buchwald
Journal: JAMA (1966)

In 1962, animal experiments in rabbits and pigs demonstrated that subtotal ileal bypass would lead to a marked decrease in cholesterol absorption capactiy and a sharp decline in circulating-cholesterol levels.<sup>1</sup>This induced lowering of the blood cholesterol level endured for the duration of the bypass period. Further work showed that although the entire small intestine has the capability to absorb cholesterol, greater amounts are taken up by the ileum. Too, the intestinal transit time plays a role in cholesterol absorption. Finally, it appears that the maximal circulating-cholesterol reduction obtainable by a limited intestinal bypass can best be achieved by subtotal ileal bypass with bypass including the ileocecal valve.<sup>2</sup>The finding of ileal preference in cholesterol absorption corroborates the earlier results of Byers and associates.<sup>3</sup>Our analysis, by statistical comparison of age and sex matched populations of human controls with patients who had undergone ileal resections for causes
Adaptations of the left ventricle to chronic pressure overload.
Authors: S Sasayama, J Ross, D Franklin, C M Bloor, S Bishop, R B Dilley
Journal: Circulation Research (1976)

Left ventricular (LV) function during the adaptation to chronic pressure overload produced by an ascending aortic constriction was analyzed in conscious dogs, instrumented with intraventricular micromanometers and pairs of ultrasonic crystals for measurement of LV wall thickness (WTh) and internal LV chamber diameter. During inflation of the cuff to produce LV pressures averaging 220 mg Hg, calculated peak wall stress (WSt) increased by 55% above control while percent shortening decreased by 24% and mean circumferential shortening velocity (VCF) decreased by 39% from control. By 9 days (mean) after aortic constriction, the cross-sectional area (CSA) of the LV wall increased by 10% and peak WSt fell to 37% above control. End-diastolic diameter (EDD) increased to 4% above control, while percent shortening and mean VCF remained reduced at -12% and -20% of control, respectively. During the phase of concentric hypertrophy (mean 2 1/2 weeks), CSA increased further to 15% above control and WSt fell to 22% above control, while EDD and percent shortening returned to control and mean VCF increased to -7% of control (not significant). At 24 hours after release of the cuff WSt, percent shortening, mean VCF, and peak velocity of LV pressure rise (peak dP/dt) were not significantly different from control. Rapid, partial regression of hypertrophy was observed in some dogs. Thus, the left ventricle responds to chronically elevated pressure by initial dilation with increased WSt followed by gradual wall thickening and consequent reduction of WSt to near normal. After successful adaptation to the pressure overload, hypertrophy per se did not produce intrinsic depression of the myocardial inotropic state.
Curbside Consultations
Authors: Farrin A. Manian
Journal: JAMA (1996)

INFORMAL or "curbside" consultations have been an important yet often an invisible part of the medical management of many patients. Indeed, questions such as "Can I get your thoughts?" or "Can I run something by you?" are familiar to many of us who specialize in purely "cognitive" disciplines such as infectious diseases. However, this subject has received little attention in the published literature.<sup>1-3</sup>Since the current health care climate is forcing examination of all important aspects of patient care, both visible and invisible, it may be timely to reexamine the pertinent issues surrounding curbside consultations. The following perspective on curbside consultations is based on our experience as infectious disease specialists in private practice who receive such consultations on almost a daily basis (occasionally four or more per day). We hope that discussion of the various aspects of curbside consultations will be the first step in refining their use without
Identifying the Primary Site in Metastatic Cancer of Unknown Origin
Authors: J. Scott Nystrom
Journal: JAMA (1979)

Two hundred sixty-six patients with metastatic nonsquamous carcinoma of unknown origin underwent upper and lower gastrointestinal series, intravenous pyelograms, and chest roentgenograms (CR) for location of a primary cancer site. Of 129 identified primary cancer sites, only 22 were verified antemortem, whereas necropsy disclosed 25 cases with falsepositive examination results. The CR patterns thought typical for lung cancer (eg, single mass lesion and hilar or mediastinal adenopathy) were often shown (43%) to represent metastatic lesions. Because contrast roentgenographic studies are costly, uncomfortable, of low yield, and often misleading, they should be limited to cases with specific organ dysfunction. (<i>JAMA</i>241:381-383, 1979)
Evaluation of Clonidine Hydrochloride (Catapres)
Authors: Mary Ellen Kosman
Journal: JAMA (1975)

Clonidine hydrochloride is a new antihypertensive agent with a primary site of action in the central nervous system. When administered with a diuretic, it is effective for long-term therapy and may be particularly useful in patients with moderately severe hypertension. Clonidine is comparable to methyldopa in efficacy but may cause side-effects more frequently. The only potentially serious adverse reaction that has been reported is a rebound increase in blood pressure that may occur following rapid withdrawal. (<i>JAMA</i>233:174-176, 1975)
The Pritikin Diet
Authors: Nathan Pritikin
Journal: JAMA (1984)

<h3>To the Editor.—</h3> Since 1976,<i>JAMA</i>has consistently reported the Pritikin Program unfairly. I thank Dr Lundberg for this opportunity to set the record straight, at least on the most recent examples. In 1981,<i>JAMA</i>reported a study by Hutchison and Brown in an article entitled "Pritikin vs AHA Diet: No Difference for Peripheral Vascular Disease."1 The so-called Pritikin diet used in the study was neither the Regression diet used at my centers and in all my research since 1974 nor the Maintenance diet described in my books meant for asymptomatic patients. My diet guidelines are as follows: less than 10% fat, 10% to 15% protein, 75% to 80% mainly complex carbohydrates, less than 25 mg of cholesterol (Regression diet), and less than 100 mg of cholesterol (Maintenance diet). Hutchison's subjects consumed<i>twice</i>the fat and<i>three times</i>the cholesterol permitted on my more lenient Maintenance diet for well people!
The Detection of Sleep Apnea in the Awake Patient
Authors: Mark H. Sanders
Journal: JAMA (1981)

We studied 21 subjects, 13 of whom had the sleep apnea hypersomnolence syndrome associated with upper airway obstruction during sleep (SAHS-UAO) to determine if "saw-toothing" on the flow-volume loop was significantly associated with the phenomenon of airway occlusion during sleep. A "saw-tooth" pattern was present on the flow-volume loop in 11 of 13 subjects with SAHS-UAO. The presence of saw-toothing correlated with fluttering of tissue that was visualized in the upper airway via the fiberoptic bronchoscope. The specificity of the saw-tooth pattern for SAHS-UAO was 100%. Generalized obesity may indirectly influence the presence of saw-toothing due to deposition of what appeared to be adipose tissue in the pharyngeal walls. Although the number of subjects in this study is small, saw-toothing on the flow-volume loop appears to be an important aid in the diagnosis of SAHS-UAO. (<i>JAMA</i>1981;245:2414-2418)
Quality, Evolution, and Clinical Implications of Randomized, Controlled Trials on the Treatment of Lung Cancer
Authors: Antonio Nicolucci
Journal: JAMA (1989)

A review of 150 published randomized trials on the treatment of lung cancer showed serious methodological drawbacks. Handling of withdrawals (only 7 trials had no dropouts), a priori estimates of sample size (only 9 trials specified the required number of patients), blinding of randomization (only 22 trials had a satisfactory procedure), and information on eligible nonrandomized patients (only 13 studies reported it precisely) were areas of major concern. Although trial quality improved over time both in<i>design/execution</i>(study size estimation and analysis by prognostic factors became more frequent) and<i>reporting</i>(information on patients' characteristics and side effects were more thoroughly reported), their evolution was inconsistent. For non—small-cell lung cancer—despite the persistent lack of proof of efficacy of any active treatment—an untreated control arm was prematurely abandoned and a wide variety of tested regimens prevailed even in better-quality studies. Slightly more promising is the picture for small-cell lung cancer, where research indicates somewhat more reliable—though limited—progress. While clinical research in lung cancer has contributed little to defining the best standard care, we conclude that its heterogeneity makes it unlikely that quantitative meta-analysis of existing trials will be constructive. (<i>JAMA</i>. 1989;262:2101-2107)
Changing Attitudes and Practices in Forgoing Life-Sustaining Treatments
Authors: Charles L. Sprung
Journal: JAMA (1990)

Advances in medical technology and practices have been associated with improved patient outcomes. At times, the price of this progress has included great financial costs and human suffering. During the last two decades, there have been significant changes in medical practices in America. In the late 1960s and early 1970s, the removal of a respirator or hydration or nutrition from a patient who was not brain dead was considered a deviation from accepted medical practices. In 1976, the<i>Quinlan</i>case allowed the removal of a ventilator from a patient in a persistent vegetative state. Subsequent court decisions in the 1980s have equated hydration and artificial feeding with other forms of life-sustaining treatments and have allowed their withdrawal in patients who were not terminally ill. Prominent physicians have recently stated that it is not immoral for a physician to assist in the rational suicide of a terminally ill patient. Active euthanasia programs in the United States are likely in the near future. (<i>JAMA</i>. 1990;263:2211-2215)
Dog Poisons Man
Authors: Ubaldo Berumen
Journal: JAMA (1983)

<h3>To the Editor.—</h3> A 23-year-old medical student saw his dog (a puppy) suddenly collapse. He started external cardiac massage and a mouth-to-nose ventilation effort. Moments later, the dog died, and the student felt nauseated, vomited, and lost consciousness. On the patient's arrival at the hospital, an alert medical officer detected a bitter almonds odor on the patient's breath and administered the accepted treatment for cyanide poisoning, after which he recovered. It turned out that the dog had accidentally swallowed cyanide, and the poison eliminated through the lungs had been inhaled by his master during the mouth-to-nose artificial respiration. I know of another case of similar nature, bizarre as it may be, involving a man and a dog.
Case and Survival Definitions in Out-of-Hospital Cardiac Arrest
Authors: Terence D. Valenzuela
Journal: JAMA (1992)

<h3>Objective.</h3> —To determine the effect of different case and survival definitions of out-of-hospital cardiac arrest on survival rate calculations. <h3>Design.</h3> —A 22-month case series of nontraumatic, out-of-hospital cardiac arrests. <h3>Setting.</h3> —Southwestern city (population, 400000; area, 390 km<sup>2</sup>) with a two-tiered emergency response system consisting of emergency medical technicians and paramedics. <h3>Patients.</h3> —A consecutive sample of 372 patients found without palpable pulse or spontaneous respiration. <h3>Main Outcome Measures.</h3> —Survival rate after cardiac arrest was calculated using three case definitions of arrest and two definitions of survival. <h3>Results.</h3> —Twenty percent of all patients survived to hospital admission and 6% survived to hospital discharge. Twenty-six percent of adults whose collapse was witnessed survived to hospital admission, and 10% survived to hospital discharge. Patients whose collapse was witnessed and who experienced initial ventricular fibrillation survived to hospital admission in 38% and to hospital discharge in 15% of cases. <h3>Conclusions.</h3> —The survival rate after out-of-hospital cardiac arrest varies widely depending on the case and survival definitions selected. To facilitate intersystem comparison and assessment of interventions designed to improve outcome, the Utstein Consensus Conference recommended that case and survival definitions should be adopted by all prehospital emergency systems. (<i>JAMA</i>. 1992;267:272-274)
Cholesterol Embolization Syndrome
Authors: Michael W. Schwartz
Journal: JAMA (1987)

Two patients developed the cholesterol embolization syndrome after coronary angiography and intravenous streptokinase therapy for acute myocardial infarction. Clinical manifestations included cyanosis, ulcers, gangrene of the hands and feet, myalgias, intestinal infarction, eosinophilia, and renal failure. One patient died; one has survived with chronic renal failure. Streptokinase therapy may expose atheromatous plaques to the circulation by lysing platelet-fibrin thrombi. (<i>JAMA</i>1987;258:1934-1935)
Intrinsic Asthma in Adults
Authors: Edward E. Mays
Journal: JAMA (1976)

Of 28 patients with severe asthma routinely examined with upper gastrointestinal (UGI) x-ray films, 18 (64%) were found to have hiatus hernia and 13 (46%) were found to have demonstrable gastroesophageal reflux. These prevalences differed significantly (<i>P</i>&lt;.001) from those seen in a control population (19% and 5%, respectively). These data suggest that aspiration of gastric acid is a frequent incitant to severe asthma and that it should be routinely sought in the treatment-resisant asthmatic patient. Intensive medical regimens directed against reflux and acidity may bring notable improvement in asthma symptoms. Surgical restoration of effective lower esophageal sphincter function has proved to be curative in other reported studies. (<i>JAMA</i>236:2626-2628, 1976)
Limited Form of Wegener Granulomatosis
Authors: Ronald E. Coutu
Journal: JAMA (1975)

Bilateral uveitis was the initial manifestation of a limited form of Wegener granulomatosis in a 47-year-old man. Diagnosis was established by biopsy of a pulmonary nodule. Subsequently, evidence of lesions developed in the patient's central and peripheral nervous systems, but renal lesions were absent. Pulmonary lesions regressed on therapy with azathioprine and prednisone. Blindness ultimately resulted from retinal phlebitis, vitreous hemorrhages, and neovascular glaucoma. (<i>JAMA</i>233:868-871, 1975)
Measles Serostatus Among Parturient Patients at 2 Philadelphia Hospitals in 2021
Authors: Dustin D. Flannery, Alvaro Zevallos Barboza, Kelly C. Wade, Madeline R. Pfeifer, Jeffrey S. Gerber, Jeffrey S. Morris, Karen M. Puopolo
Journal: JAMA (2023)

This observational study explores whether rubella serostatus, which is routinely assessed during pregnancy, can serve as a proxy for measles serostatus in parturient persons.
Breast and Lung Cancer Screening Among Medicare Enrollees During the COVID-19 Pandemic
Authors: Christopher Doan, Shuang Li, James S. Goodwin
Journal: JAMA Network Open (2023)

Several studies reported sharp decreases in screening mammography for breast cancer and low-dose computed tomographic screening for lung cancer in the early months of the COVID-19 pandemic, followed by a return to normal or near-normal levels in the summer of 2020.To determine the observed vs expected mammography and low-dose computed tomographic scan rates from the beginning of the pandemic through April 2022.In this retrospective cohort study assessing mammography and low-dose computed tomography rates from January 2017 through April 2022, data for January 2016 to February 2020 were used to generate expected rates for the period March 2020 to April 2022. The study included a 20% national sample of Medicare fee-for-service enrollees among women aged 50 to 74 years for mammography, and men and women aged 55 to 79 years for low-dose computed tomographic scan.Receipt of screening mammography or low-dose computed tomographic scan.The yearly cohorts for the mammography rates included more than 1 600 000 women aged 50 to 74 years, and the cohorts for the low-dose computed tomographic scan rates included more than 3 700 000 men and women aged 55 to 79 years. From January 2017 through February 2020, monthly mammography rates were flat, whereas there was a monotonic increase in low-dose computed tomographic scan rates, from approximately 500 per million per month in early 2017 to 1100 per million per month by January 2020. Over the period from March 2020 to April 2022, there were episodic drops in both mammography and low-dose computed tomographic scan rates, coincident with increases in national COVID-19 infection rates. For the periods from March 2020 to February 2020 and March 2021 to February 2022, the observed low-dose computed tomographic scan rates were 24% (95% CI, 23%-24%) and 14% (95% CI, 13%-15%) below expected rates, whereas mammography rates were 17% (95% CI, 17%-18%) and 4% (95% CI, 4%-3%) below expected.In this cohort study, the decreases in cancer screening during the early phases of the COVID-19 pandemic did not resolve after the initial pandemic surges. Successful interventions to improve screening rates should address pandemic-specific reasons for low screening participation.
The Oral PI3Kδ Inhibitor Linperlisib for the Treatment of Relapsed and/or Refractory Follicular Lymphoma: A Phase II, Single-Arm, Open-Label Clinical Trial
Authors: Tingyu Wang, Xiuhua Sun, Lihua Qiu, Hang Su, Junning Cao, Zhiming Li, Yuqin Song, Li Zhang, Dengju Li, Huijing Wu, Wei Zhang, Junmin Li, Keshu Zhou, Hui Zhou, Yu Yang, Zhifeng Li, Hong Cen, Zhen Cai, Zhihui Zhang, Weijun Fu, Jie Jin, Fei Li, Weixin Wu, Xuekui Gu, Weiliang Zhu, Lihong Liu, Zengjun Li, Shuhua Yi, Hanying Bao, Zusheng Xu, Lugui Qiu
Journal: Clinical Cancer Research (2023)

Abstract Purpose: To investigate the efficacy and safety of the novel orally active PI3Kδ inhibitor in relapsed and/or refractory patients with follicular lymphoma (FL) who had received at least two prior systemic treatments. Patients and Methods: Histologically confirmed relapsed and/or refractory patients with FL with disease progression after receiving second-line or greater systemic therapy were enrolled. Linperlisib was administered at 80 mg every day, orally in a 28-day cycle until disease progression or intolerable toxicity occurred. The primary outcome for the study was the objective response rate (ORR), with secondary outcomes including the duration of response (DOR), progression-free survival (PFS), overall survival (OS), disease control rate, and drug safety profile. Results: Of 114 screened relapsed and/or refractory patients with FL, 84 were enrolled in the full analysis set (FAS). The ORR of the 84 FAS patients was 79.8% [95% confidence interval (CI), 69.6–87.8, 67 patients], with 13 patients (15.5%) achieving a complete response and 54 patients (64.3%) with a partial response. The median DOR was 12.3 months (95% CI, 9.3–15.9). The median PFS was 13.4 months (95% CI, 11.1–16.7). The 12-month OS rate was 91.4% (95% CI, 82.7–95.8) and a median OS not reached by 42 months. The most frequent (&amp;gt;3%) treatment-related adverse events Grade ≥3 were infectious pneumonia (19.0%), neutropenia (15.5%), decreased lymphocyte count (4.8%), decreased leukocyte count (4.8%), increased lipase (3.6%), decreased platelet count (3.6%), hypertriglyceridemia (3.6%), and interstitial lung disease (3.6%). Conclusions: Linperlisib demonstrated compelling clinical activity and manageable tolerability for relapsed and/or refractory patients with FL who had received at least two prior systemic therapies.